Comparing Rates of Turnaround Time and Primary Medication Nonadherence Among Patients at Vanderbilt Specialty Pharmacy Compared to External Specialty Pharmacies
1 Demographics
| Characteristic | N | Filling pharmacy | p-value2 | Overall, N = 17921 | ||
|---|---|---|---|---|---|---|
| Never filled, N = 4251 | Non-Vanderbilt, N = 4701 | Vanderbilt, N = 8971 | ||||
| Time to fill (days) | 1369 | 0.476 | ||||
| Mean (SD) | 2.5 (3.5) | 8.6 (18.8) | 6.1 (12.6) | 7.0 (15.1) | ||
| Median (IQR) | 2.5 (1.3 - 3.8) | 3.0 (1.0 - 8.0) | 3.0 (1.0 - 6.0) | 3.0 (1.0 - 7.0) | ||
| Range | 0.0 - 5.0 | 0.0 - 180.0 | 0.0 - 146.0 | 0.0 - 180.0 | ||
| Missing | 423 | 0 | 0 | 423 | ||
| Age at Index Date | 1792 | <0.001 | ||||
| Mean (SD) | 57.5 (17.1) | 51.9 (15.5) | 57.6 (16.4) | 56.0 (16.5) | ||
| Median (IQR) | 62.0 (46.0 - 71.0) | 53.0 (41.0 - 61.0) | 60.0 (46.0 - 70.0) | 58.0 (44.0 - 69.0) | ||
| Range | 18.0 - 90.0 | 18.0 - 98.0 | 18.0 - 93.0 | 18.0 - 98.0 | ||
| Sex | 1792 | 0.186 | ||||
| Female | 227 (53.4%) | 270 (57.4%) | 469 (52.3%) | 966 (53.9%) | ||
| Male | 198 (46.6%) | 200 (42.6%) | 428 (47.7%) | 826 (46.1%) | ||
| Race (recategorized) | 1706 | 0.056 | ||||
| Black | 28 (7.00%) | 54 (11.9%) | 101 (11.8%) | 183 (10.7%) | ||
| Other | 13 (3.25%) | 16 (3.53%) | 38 (4.45%) | 67 (3.93%) | ||
| White | 359 (89.8%) | 383 (84.5%) | 714 (83.7%) | 1456 (85.3%) | ||
| Missing | 25 | 17 | 44 | 86 | ||
| Insurance (recategorized) | 1735 | <0.001 | ||||
| Commercial | 189 (46.6%) | 323 (70.5%) | 400 (45.9%) | 912 (52.6%) | ||
| Government/ Other | 217 (53.4%) | 135 (29.5%) | 471 (54.1%) | 823 (47.4%) | ||
| Missing | 19 | 12 | 26 | 57 | ||
| Clinic | 1792 | <0.001 | ||||
| inf | 189 (44.5%) | 188 (40.0%) | 246 (27.4%) | 623 (34.8%) | ||
| ms | 52 (12.2%) | 49 (10.4%) | 67 (7.47%) | 168 (9.38%) | ||
| onc | 184 (43.3%) | 233 (49.6%) | 584 (65.1%) | 1001 (55.9%) | ||
| Pharmacy medication sent to | 1792 | <0.001 | ||||
| Non-Vanderbilt | 286 (67.3%) | 363 (77.2%) | 34 (3.79%) | 683 (38.1%) | ||
| Vanderbilt | 139 (32.7%) | 107 (22.8%) | 863 (96.2%) | 1109 (61.9%) | ||
| 1 n (%) | ||||||
| 2 Kruskal-Wallis rank sum test; Pearson’s Chi-squared test | ||||||
2 PMN and TAT results
2.1 By filling pharmacy
| Characteristic | N | Filling pharmacy | p-value2 | Overall, N = 17921 | ||
|---|---|---|---|---|---|---|
| Never filled, N = 4251 | Non-Vanderbilt, N = 4701 | Vanderbilt, N = 8971 | ||||
| PMN | 1792 | <0.001 | ||||
| Not PMN | 5 (1.18%) | 460 (97.9%) | 886 (98.8%) | 1351 (75.4%) | ||
| PMN | 420 (98.8%) | 10 (2.13%) | 11 (1.23%) | 441 (24.6%) | ||
| PMN case | 1792 | <0.001 | ||||
| Filled <= 60 days | 5 (1.18%) | 460 (97.9%) | 886 (98.8%) | 1351 (75.4%) | ||
| Filled > 60 days | 43 (10.1%) | 10 (2.13%) | 11 (1.23%) | 64 (3.57%) | ||
| Never filled | 377 (88.7%) | 0 (0%) | 0 (0%) | 377 (21.0%) | ||
| fw60 | 1415 | <0.001 | ||||
| FALSE | 43 (89.6%) | 10 (2.13%) | 11 (1.23%) | 64 (4.52%) | ||
| TRUE | 5 (10.4%) | 460 (97.9%) | 886 (98.8%) | 1351 (95.5%) | ||
| Missing | 377 | 0 | 0 | 377 | ||
| Time to fill (days) | 1369 | 0.476 | ||||
| Mean (SD) | 2.5 (3.5) | 8.6 (18.8) | 6.1 (12.6) | 7.0 (15.1) | ||
| Median (IQR) | 2.5 (1.3 - 3.8) | 3.0 (1.0 - 8.0) | 3.0 (1.0 - 6.0) | 3.0 (1.0 - 7.0) | ||
| Range | 0.0 - 5.0 | 0.0 - 180.0 | 0.0 - 146.0 | 0.0 - 180.0 | ||
| Missing | 423 | 0 | 0 | 423 | ||
| Time to fill (include <= 60days) | 1347 | 0.648 | ||||
| Mean (SD) | 2.5 (3.5) | 6.3 (9.3) | 5.1 (8.0) | 5.5 (8.5) | ||
| Median (IQR) | 2.5 (1.3 - 3.8) | 3.0 (1.0 - 8.0) | 3.0 (1.0 - 6.0) | 3.0 (1.0 - 6.0) | ||
| Range | 0.0 - 5.0 | 0.0 - 57.0 | 0.0 - 57.0 | 0.0 - 57.0 | ||
| Missing | 423 | 11 | 11 | 445 | ||
| Time to fill (include > 60days) | 22 | 0.717 | ||||
| Mean (SD) | NA (NA) | 105.2 (46.2) | 90.7 (25.2) | 98.0 (37.1) | ||
| Median (IQR) | NA (NA - NA) | 88.0 (68.5 - 139.5) | 90.0 (71.0 - 101.5) | 89.0 (69.3 - 108.5) | ||
| Range | Inf - -Inf | 65.0 - 180.0 | 65.0 - 146.0 | 65.0 - 180.0 | ||
| Missing | 425 | 459 | 886 | 1770 | ||
| Lengthy TAT (> 14 days) | 1369 | <0.001 | ||||
| No | 2 (100.0%) | 402 (85.5%) | 827 (92.2%) | 1231 (89.9%) | ||
| Yes | 0 (0%) | 68 (14.5%) | 70 (7.80%) | 138 (10.1%) | ||
| Missing | 423 | 0 | 0 | 423 | ||
| 1 n (%) | ||||||
| 2 Pearson’s Chi-squared test; Fisher’s exact test; Kruskal-Wallis rank sum test | ||||||
2.2 TAT by clinic
| Characteristic | MS | Oncology | Inflammatory | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N | Non-Vanderbilt, N = 49 | Vanderbilt, N = 67 | p-value1 | Overall, N = 116 | N | Non-Vanderbilt, N = 233 | Vanderbilt, N = 584 | p-value1 | Overall, N = 817 | N | Non-Vanderbilt, N = 188 | Vanderbilt, N = 246 | p-value1 | Overall, N = 434 | |
| Time to fill (days) | 116 | 0.831 | 817 | 0.089 | 434 | <0.001 | |||||||||
| Mean (SD) | 6.7 (14.6) | 4.8 (9.9) | 5.6 (12.1) | 6.1 (18.1) | 6.3 (12.3) | 6.2 (14.2) | 12.2 (20.2) | 6.1 (13.9) | 8.8 (17.2) | ||||||
| Median (IQR) | 2.0 (0.0 - 5.0) | 2.0 (1.0 - 5.0) | 2.0 (0.0 - 5.0) | 2.0 (1.0 - 6.0) | 3.0 (1.0 - 6.0) | 3.0 (1.0 - 6.0) | 5.0 (1.0 - 14.3) | 2.0 (1.0 - 6.0) | 3.0 (1.0 - 8.0) | ||||||
| Range | 0.0 - 90.0 | 0.0 - 65.0 | 0.0 - 90.0 | 0.0 - 180.0 | 0.0 - 119.0 | 0.0 - 180.0 | 0.0 - 169.0 | 0.0 - 146.0 | 0.0 - 169.0 | ||||||
| 1 Wilcoxon rank sum test | |||||||||||||||
2.3 Reasons for PMN
| Characteristic | N | Index Stelara | Overall, N = 19311 | |
|---|---|---|---|---|
| No, N = 17921 | Yes, N = 1391 | |||
| Sample provided for 1st fill? | 24 | |||
| No | 20 (100.0%) | 3 (75.0%) | 23 (95.8%) | |
| Yes | 0 (0%) | 1 (25.0%) | 1 (4.17%) | |
| Missing | 1772 | 135 | 1907 | |
| Did patient fill their medication? | 655 | |||
| Yes | 164 (29.1%) | 69 (75.8%) | 233 (35.6%) | |
| No | 393 (69.7%) | 21 (23.1%) | 414 (63.2%) | |
| Unknown | 7 (1.24%) | 1 (1.10%) | 8 (1.22%) | |
| Missing | 1228 | 48 | 1276 | |
| Is the fill date available? | 72 | |||
| No | 22 (40.0%) | 1 (5.88%) | 23 (31.9%) | |
| Yes | 33 (60.0%) | 16 (94.1%) | 49 (68.1%) | |
| Missing | 1737 | 122 | 1859 | |
| Reason for PMN | 102 | |||
| Medication change | 4 (4.12%) | 0 (0%) | 4 (3.92%) | |
| Patient unable to afford | 15 (15.5%) | 0 (0%) | 15 (14.7%) | |
| Medication no longer clinically appropriate | 4 (4.12%) | 1 (20.0%) | 5 (4.90%) | |
| Patient decision | 26 (26.8%) | 1 (20.0%) | 27 (26.5%) | |
| Medication never approved by insurance | 22 (22.7%) | 0 (0%) | 22 (21.6%) | |
| Patient death | 2 (2.06%) | 0 (0%) | 2 (1.96%) | |
| Patient unreachable | 1 (1.03%) | 0 (0%) | 1 (0.98%) | |
| Medication held | 4 (4.12%) | 0 (0%) | 4 (3.92%) | |
| Lost to follow-up | 4 (4.12%) | 0 (0%) | 4 (3.92%) | |
| Provider Change | 1 (1.03%) | 0 (0%) | 1 (0.98%) | |
| Unknown due to sent to external pharmacy and never received | 8 (8.25%) | 2 (40.0%) | 10 (9.80%) | |
| Other | 6 (6.19%) | 1 (20.0%) | 7 (6.86%) | |
| Missing | 1695 | 134 | 1829 | |
| Reason for turnaround time >14 days | 206 | |||
| Insurance Delays (PA denied, awaiting appeal) | 26 (18.8%) | 2 (2.94%) | 28 (13.6%) | |
| Patient Decision (vacation, life event, etc.) | 12 (8.70%) | 0 (0%) | 12 (5.83%) | |
| Unable to contact patient | 12 (8.70%) | 0 (0%) | 12 (5.83%) | |
| Pharmacy Delay (logistical barriers) | 35 (25.4%) | 2 (2.94%) | 37 (18.0%) | |
| Financial Assistance Pending | 8 (5.80%) | 1 (1.47%) | 9 (4.37%) | |
| Medication administration timing dependent on other medication (awaiting infusion) | 10 (7.25%) | 59 (86.8%) | 69 (33.5%) | |
| Physician Hold (Reviewing recommendations, safety with other conditions, waiting for labs) | 12 (8.70%) | 0 (0%) | 12 (5.83%) | |
| Patient Hospitalized | 1 (0.72%) | 1 (1.47%) | 2 (0.97%) | |
| Patient received free medication (sample) | 2 (1.45%) | 1 (1.47%) | 3 (1.46%) | |
| Medication Change | 5 (3.62%) | 0 (0%) | 5 (2.43%) | |
| Unknown due to filled by external pharmacy | 13 (9.42%) | 2 (2.94%) | 15 (7.28%) | |
| Unknown | 2 (1.45%) | 0 (0%) | 2 (0.97%) | |
| Provider/clinic logistical error | 0 (0%) | 0 (0%) | 0 (0%) | |
| Missing | 1654 | 71 | 1725 | |
| Reason fill date not available | 23 | |||
| External compounding pharmacy - no fill in surescripts | 1 (4.55%) | 0 (0%) | 1 (4.35%) | |
| external pharmacy | 7 (31.8%) | 1 (100.0%) | 8 (34.8%) | |
| External pharmacy - pt. received in Epic | 1 (4.55%) | 0 (0%) | 1 (4.35%) | |
| external pharmacy (Accredo) | 1 (4.55%) | 0 (0%) | 1 (4.35%) | |
| External pharmacy (accredo) - pt. received in Epic | 5 (22.7%) | 0 (0%) | 5 (21.7%) | |
| External pharmacy (CVS) | 1 (4.55%) | 0 (0%) | 1 (4.35%) | |
| External pharmacy (Homescripts) | 1 (4.55%) | 0 (0%) | 1 (4.35%) | |
| External pharmacy (Kroger) | 1 (4.55%) | 0 (0%) | 1 (4.35%) | |
| External pharmacy (walgreens) | 1 (4.55%) | 0 (0%) | 1 (4.35%) | |
| Filled at external pharmacy | 1 (4.55%) | 0 (0%) | 1 (4.35%) | |
| filled by VA | 1 (4.55%) | 0 (0%) | 1 (4.35%) | |
| Filled with VA | 1 (4.55%) | 0 (0%) | 1 (4.35%) | |
| Missing | 1770 | 138 | 1908 | |
| Reason medication was not filled | 18 | |||
| allergic reaction to IV; prescription cancelled | 0 (0%) | 1 (25.0%) | 1 (5.56%) | |
| Changed to infusion (5-FU) | 1 (7.14%) | 0 (0%) | 1 (5.56%) | |
| external pharmacy - no fill in surescripts | 6 (42.9%) | 2 (50.0%) | 8 (44.4%) | |
| Financial reasons | 1 (7.14%) | 0 (0%) | 1 (5.56%) | |
| PAP | 1 (7.14%) | 0 (0%) | 1 (5.56%) | |
| Patient decision | 1 (7.14%) | 0 (0%) | 1 (5.56%) | |
| patient decision- thought she had a reaction | 0 (0%) | 1 (25.0%) | 1 (5.56%) | |
| too expensive | 1 (7.14%) | 0 (0%) | 1 (5.56%) | |
| Uknown | 1 (7.14%) | 0 (0%) | 1 (5.56%) | |
| unable to obtain from Accredo | 1 (7.14%) | 0 (0%) | 1 (5.56%) | |
| unable to reach specialty pharmacy | 1 (7.14%) | 0 (0%) | 1 (5.56%) | |
| Missing | 1778 | 135 | 1913 | |
| 1 n (%) | ||||
3 Adherence and persistence
Patients with fills from both ERX and Surescripts were classified if 50% or more of their fills came from ERX data.
3.1 PDC for entire study period
| Characteristic | N | Non-VSP, N = 467 | VSP, N = 632 | p-value1 | Overall, N = 1099 |
|---|---|---|---|---|---|
| PDC | 1099 | 0.018 | |||
| Mean (SD) | 0.85 (0.19) | 0.89 (0.16) | 0.87 (0.17) | ||
| Median (IQR) | 0.93 (0.76 - 1.00) | 0.96 (0.82 - 1.00) | 0.95 (0.80 - 1.00) | ||
| Range | 0.13 - 1.00 | 0.19 - 1.00 | 0.13 - 1.00 | ||
| fills | 1099 | 0.123 | |||
| Mean (SD) | 9.15 (4.66) | 9.50 (4.54) | 9.35 (4.59) | ||
| Median (IQR) | 8.00 (5.00 - 12.00) | 9.00 (6.00 - 13.00) | 9.00 (6.00 - 12.00) | ||
| Range | 3.00 - 24.00 | 3.00 - 25.00 | 3.00 - 25.00 | ||
| denom | 1099 | 0.628 | |||
| Mean (SD) | 289.84 (163.89) | 282.32 (152.58) | 285.52 (157.45) | ||
| Median (IQR) | 276.00 (168.00 - 385.00) | 266.00 (160.50 - 390.25) | 269.00 (165.00 - 389.50) | ||
| Range | 15.00 - 743.00 | 28.00 - 746.00 | 15.00 - 746.00 | ||
| 1 Wilcoxon rank sum test | |||||
3.2 One year PDC
Patients with fills from both ERX and Surescripts were classified if 50% or more of their fills came from ERX data.
| Characteristic | N | Non-VSP, N = 473 | VSP, N = 626 | p-value1 | Overall, N = 1099 |
|---|---|---|---|---|---|
| PDC | 1088 | 0.030 | |||
| Mean (SD) | 0.86 (0.18) | 0.89 (0.16) | 0.88 (0.17) | ||
| Median (IQR) | 0.94 (0.79 - 1.00) | 0.96 (0.84 - 1.00) | 0.96 (0.82 - 1.00) | ||
| Range | 0.18 - 1.00 | 0.12 - 1.00 | 0.12 - 1.00 | ||
| Missing | 9 | 2 | 11 | ||
| fills | 1099 | 0.011 | |||
| Mean (SD) | 7.95 (3.74) | 8.44 (3.47) | 8.23 (3.60) | ||
| Median (IQR) | 8.00 (5.00 - 11.00) | 8.50 (6.00 - 12.00) | 8.00 (5.00 - 11.00) | ||
| Range | 1.00 - 24.00 | 1.00 - 16.00 | 1.00 - 24.00 | ||
| denom | 1099 | 0.280 | |||
| Mean (SD) | 233.77 (104.66) | 241.09 (100.81) | 237.94 (102.50) | ||
| Median (IQR) | 249.00 (154.00 - 334.00) | 253.50 (156.25 - 339.00) | 252.00 (154.00 - 337.00) | ||
| Range | 0.00 - 365.00 | 0.00 - 365.00 | 0.00 - 365.00 | ||
| 1 Wilcoxon rank sum test | |||||
3.2.1 One year PDC comparison by clinic
| Characteristic | MS | Oncology | Inflammatory | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N | Non-VSP, N = 26 | VSP, N = 56 | p-value1 | N | Non-VSP, N = 218 | VSP, N = 309 | p-value1 | N | Non-VSP, N = 229 | VSP, N = 261 | p-value1 | |
| PDC | 78 | 0.010 | 524 | 0.143 | 486 | 0.399 | ||||||
| Mean (SD) | 0.75 (0.21) | 0.86 (0.19) | 0.86 (0.17) | 0.88 (0.19) | 0.87 (0.18) | 0.91 (0.11) | ||||||
| Median (IQR) | 0.82 (0.61 - 0.94) | 0.94 (0.77 - 1.00) | 0.92 (0.79 - 1.00) | 0.98 (0.81 - 1.00) | 0.95 (0.79 - 1.00) | 0.96 (0.88 - 1.00) | ||||||
| Range | 0.35 - 1.00 | 0.24 - 1.00 | 0.27 - 1.00 | 0.12 - 1.00 | 0.18 - 1.00 | 0.47 - 1.00 | ||||||
| Missing | 4 | 0 | 2 | 1 | 3 | 1 | ||||||
| 1 Wilcoxon rank sum test | ||||||||||||
3.3 One year persistence
Patients with fills from both ERX and Surescripts were classified if 50% or more of their fills came from ERX data.
| Characteristic | N | Pharmacy | p-value2 | Overall, N = 10991 | |
|---|---|---|---|---|---|
| Non-VSP, N = 4721 | VSP, N = 6271 | ||||
| np | 1099 | 0.063 | |||
| No | 129 (27.3%) | 204 (32.5%) | 333 (30.3%) | ||
| Yes | 343 (72.7%) | 423 (67.5%) | 766 (69.7%) | ||
| Time on medication | 1099 | 0.036 | |||
| Mean (SD) | 243.6 (106.9) | 256.5 (105.1) | 251.0 (106.0) | ||
| Median (IQR) | 254.0 (143.0 - 365.0) | 282.0 (158.0 - 365.0) | 270.0 (150.0 - 365.0) | ||
| Range | 31.0 - 365.0 | 35.0 - 365.0 | 31.0 - 365.0 | ||
| fills | 1099 | 0.002 | |||
| Mean (SD) | 7.1 (4.2) | 7.8 (4.0) | 7.5 (4.1) | ||
| Median (IQR) | 6.0 (3.8 - 10.0) | 7.0 (4.0 - 12.0) | 7.0 (4.0 - 11.0) | ||
| Range | 1.0 - 24.0 | 1.0 - 16.0 | 1.0 - 24.0 | ||
| 1 n (%) | |||||
| 2 Pearson’s Chi-squared test; Wilcoxon rank sum test | |||||
3.3.1 One year Persistence comparison by clinic
| Characteristic | N | Non-VSP, N = 4721 | VSP, N = 6271 |
|---|---|---|---|
| source | 1099 | ||
| erx | 0 (0%) | 589 (93.9%) | |
| mixed | 32 (6.78%) | 38 (6.06%) | |
| surescripts | 440 (93.2%) | 0 (0%) | |
| Filling pharmacy | 1099 | ||
| Never filled | 16 (3.39%) | 7 (1.12%) | |
| Non-Vanderbilt | 405 (85.8%) | 11 (1.75%) | |
| Vanderbilt | 51 (10.8%) | 609 (97.1%) | |
| 1 n (%) | |||
| Characteristic | MS | Oncology | Inflammatory | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N | Non-VSP, N = 271 | VSP, N = 551 | p-value2 | N | Non-VSP, N = 2151 | VSP, N = 3121 | p-value2 | N | Non-VSP, N = 2301 | VSP, N = 2601 | p-value2 | |
| Non-persistent | 82 | 0.196 | 527 | 0.444 | 490 | 0.001 | ||||||
| No | 6 (22.2%) | 20 (36.4%) | 53 (24.7%) | 68 (21.8%) | 70 (30.4%) | 116 (44.6%) | ||||||
| Yes | 21 (77.8%) | 35 (63.6%) | 162 (75.3%) | 244 (78.2%) | 160 (69.6%) | 144 (55.4%) | ||||||
| 1 n (%) | ||||||||||||
| 2 Pearson’s Chi-squared test | ||||||||||||